Provider Demographics
NPI:1407181787
Name:GRODOFSKY, JILL ROBIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ROBIN
Last Name:GRODOFSKY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1687
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20849-1687
Mailing Address - Country:US
Mailing Address - Phone:301-649-7170
Mailing Address - Fax:301-260-8487
Practice Address - Street 1:21628 GENTRY LN
Practice Address - Street 2:
Practice Address - City:BROOKEVILLE
Practice Address - State:MD
Practice Address - Zip Code:20833-1813
Practice Address - Country:US
Practice Address - Phone:301-649-7170
Practice Address - Fax:301-260-8487
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005822235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist